We observed significant local variation in how GP services are accessed during our research. This may have become more pronounced during the pandemic.
Practices are widely trying to manage demand by time-limiting, or completely turning off, access to online consultation tools. Many have turned off the ability to book appointments online. Some have limited the ability to book appointments so that the only option is for citizens to phone in the morning to request a same-day appointment.
These actions are understandable given the struggle to meet demand and the specific challenges of the pandemic. However, these are not citizen-centred decisions and they do risk disadvantaging some citizens.
Channel choice may increase diversity
We saw some evidence that the variation in access models (see section 5.7) may affect health outcomes for citizens from practice to practice. Those that had opened online consultation services reported increased diversity in the groups of people presenting through these new channels. The implication is that offering a choice of channels can improve presentation rates for certain groups, potentially improving health outcomes and reducing cost in the wider health and care system. Limiting options may be having the reverse effect.
Also, a study into the effects of COVID in Wales (the Locked out report, 2021) describes how inequality has become even sharper for disabled people since 2019. Access to healthcare is one of many areas significantly affected. Root causes include simple lack of consideration about the impact of recent changes, says the report.
As demand has grown, one area where inequality may be increasing is where citizens who would be considered vulnerable due to their health conditions are not recognised as such by a “one size fits all” appointment booking process. Two participants with severe, chronic illness, reported receiving no preferential treatment when trying to see a GP. After long waits on hold on the phone, they were put through the same care navigation process as everyone else.